RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	caSE:  PD-2017-05696
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “fibromyalgia” with a disability rating of 0%.

CI CONTENTION:  “Pharmacy records were not pulled from Fort Gordon where a lot of medications was received.  The rheumatologist defaulted to fibromyalgia because I showed a negative “ANA” but my primary care doctors believed I had SLE (lupus).” The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20050214	VARD - 20060314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	0%	Fibromyalgia	5025	40%	20060215	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Fibromyalgia (FM).  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with FM by a rheumatologist in January 2003 with complaints of bilateral knee pain, migratory shoulder, wrist and hip pain, and increased fatigue.   Physical examination was normal except for 13/18 positive FM tender points.  Screening for other connective tissue or metabolic disorders was negative.  At a rheumatology visit on 15 May 2003, the CI reported that even though she took an anti-depressant for FM at bedtime, she slept poorly and felt unrested after waking.  She also stated that walking 2-3 miles per day and using a non-steroidal anti-inflammatory drug (NSAID) was somewhat helpful.  Physical examination showed tenderness of trapezius tender points.  At a rheumatology follow-up on 24 August 2003, she was not taking the currently prescribed anti-depressant because it made her too sleepy in the mornings and she missed morning formation; but when she took it on the weekends, she felt much better.  She reported working 75- 80 hours per week and felt excessively tired all the time.  

The 27 October 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of knee pain, and intermittent migratory shoulder and hip pain, without swelling.  She reported pain in all joints, rated at 5/10, and continued to experience headaches, fatigue, memory loss, and poor sleep.  Physical therapy had not been helpful and current medications included an anti-depressant at bedtime (and as needed during the day), a muscle relaxant, and NSAID, which had not “helped fully.”  She walked up to 7 miles per week.  Physical examination showed full ROM of all joints, without synovitis, but with 16/18 fibromyalgia tender points.  A patellar apprehension test was positive. 

At the 15 February 2006 VA Compensation and Pension (C&P) general medical, FM, joint, and spine examinations, 11 months after separation (all performed by the same VA examiner on the same day), the CI reported daily joint pain and morning stiffness, poor sleep, fatigue and depression, which was believed to be related to the FM condition.  Symptoms were aggravated by cold weather and helped by heat, and she took an anti-depressant and anti-inflammatory as needed.  Physical examination showed greater than 11/18 FM tender points (occiput and lower cervical, trapezius supraspinatus, and gluteal muscles and knees bilaterally).  Joint ROM was normal except for both knees and ankles, and the left hip.  Bilateral knee ROM measurements showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal), with otherwise normal knee findings.  Bilateral ankle ROM revealed dorsiflexion of 20 degrees (normal) and plantar flexion of 40 degrees (normal 45).  Left hip ROM showed flexion of 120 degrees (normal 125) and normal extension and abduction, and external rotation of 40 degrees (normal 60).  The ROM of all of these joints was pain-free with no additional limitation following repetition.  Thoracolumbar ROM showed flexion of 80 degrees and normal lateral flexion and rotation, all without pain or additional limitation after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the fibromyalgia 0%, coded 5025 (fibromyalgia), citing no requirement for continuous medication for control.  The VA rated the fibromyalgia 40%, coded 5025, based on the C&P examination, citing widespread musculoskeletal pain and tender points with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms depression, anxiety or Raynaud’s like symptoms that are constant or nearly so and refractory to therapy.    Panel members agreed that a 20 % rating was supported for fibromyalgia with symptoms that were constant or nearly so, but the evidence did not support that they were “refractive to therapy.”  The CI reported benefit from heat, as well as anti-inflammatory and anti-depressant medications for FM.  Although she did not take one prescribed anti-depressant during the workweek due to fatigue, she felt better when able to take it.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the FM, coded 5025.  

BOARD FINDINGS:  In the matter of the fibromyalgia, the panel recommends a disability rating of 20% coded 5025 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Fibromyalgia	5025	20%	

 

PD-2017-05696

XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

PD-2017-05696